STANDARDS 


DEPARTMENT  OF  HEALTH  AND  SANITATION 


yNITED  STATES  SHIPPING  BOARD 
EMERGENCY  FLEET  CORPORATION 


1918 


LIEUT- COL.  PHILIP  S.  DOANE 

DIRECTOR 


CONTENTS 


IXTRODUCTIOX    5 

HEALTH  OF  WORKERS 

GENERAL  7 

EXAMINATION  OF  WORKERS.  7 

DISEASES 

Communicable  Diseases    9 

\'enereal   Diseases    9 

\'accination     for     Smallpox     and 

Typhoid    9 

MEDICAL  TREATMENT 

Prevention  of  Infection 9 

Treatment  of  Wounds 9 

STAFF 

First  Aid  Attendants  and  Doctors 

on  Call   10 

Resident    Physician    10 

TREATMENT  FACILITIES 

First  Aid  Station 10 

Dispensary    10 

Hospital   10 

Stretchers    11 

Ambulance 11 

Heat   Prostration    11 

Municipal  and  Private  Hospitals..  11 

FIRST  AID  STATION 

Location  11 

Plans     11 

Equipment   12 

Supplies     12 

DISPEXSARY 

Location   13 

Plans    13 

Equipment   , 13 

Supplies   13 

YARD  HOSPITAL 

Location   13 

Plans  and   Equipment 13 


SANITATION 

WATER  SUPPLY 

Source    14 

Quality   14 

Pressure     15 

Distribution     15 

Dual  Connections   15 

TOILETS 

General  16 

Water  Closets  and  Urinals 17 

Privies    17 

SEWAGE  DISPOSAL   17 

WASH  ROOMS    17 

DRESSING   ROOMS    19 

CLEANING    AND    DISINFECT- 
ANT     19 

GARBAGE  DISPOSAL   19 

MANURE  DISPOSAL  20 

AHSCELLANEOUS  REFUSE  ....  20 

INSECTS 

Mosquitoes    20 

Flies    21 

RESTAURANTS   AND    LUNCH- 
ROOMS 

GENERAL  DESIGN  22 

HEALTH  OF  FOOD  HANDLERS  22 

KITCHEN    23 

FOODS   2i 

LUNCH-ROOM   FACILITIES    ...  24 

LUNCH  PERIOD  24 

HOUSING 

GENERAL  DFSIG.X    24 

SANITARY  EQUIPMENT   25 

RECREATIOX  FACILITIES   ....  25 

LAUXDRY    25 

JAXITOR   SER\ICE    25 

APPROVAL  OF  PLAXS 25 


736459 


INTRODUCTION 


A  healthy  and  energetic  force  of  workmen  is  as  essential  to  the 
speedy  constrnction  of  the  ships  as  a  welMai(l-(»ut  yard,  prompt  de- 
livery of  materials,  labor-saving  machinery  or  e!ticient  methods  of 
work. 

The  building  and  operation  of  ships  l)y  the  V.  S.  Shipjiiug  Board 
Emergency  Fleet  Corporation  is  the  greatest  industrial  task  ever 
undertaken,  and  being  a  governmental  activity,  the  hygienic  and 
sanitary  standards  under  which  this  work  is  carried  (»n  should  be 
worthy  of  adoption  by  private  industry. 

The  liealth  of  the  workers  also  has  a  very  direct  influence  upon 
the  cost  of  building  ships,  for  a  dollar's  worth  of  work  should  be  ob- 
tained for  every  dollar  paid  in  wages.  This  is  not  ]!(tssil)le  with  em- 
ployees in  ill  health  or  with  lowered  vitality. 

To  obtain  such  conditions  it  is  necessary  that  the  principles  of 
industrial  sanitation  as  established  by  actual  j)ractice  sliall  be  clearly 
understood  and  strictly  conformed  to. 

This  requires  tlie  expenditure  of  funds.  l»ut  experience  has  clearly 
demonstrated  that  the  investment  pays  dividends. 

The  enormous  increase  in  the  shi])]iuilding  industry  to  meet  war 
needs  has  caused  a  constant  influx  of  workmen  into  tlie  slii])yards  wiio 
are  unu.sed  to  the  rigor  and  exiiosure  of  shipltuihliiig.  This  condition 
demands  unusual  care  to  safeguard  their  vitality. 

The  above  conditions  liave  been  the  guiding  i»rincii>les  in  the  prep- 
aration of  this  bulletin,  and  it^is  hoped  tliat  the  closest  ]»ossible  co- 
operation may  be  obtained  between  the  sliipyard  managers  and  the 
Department  of  Health  and  Sanitatiitn  (»r  the  Tnited  States  Shipping 
Board  Emergency  Fleet  Corjtoration.  whereby  these  problems  may  be 
met  and  worked  out  in  a  mutual  sj)irit  of  imrjtose  to  speedily  build 
ships. 


HEALTH    OF  WORKERS 

GENERAL 

1.  The  health  of  the  worker  may  l>e  considered  from  two  staud- 
X)oiiits:  (1)  That  which  considers  the  hygiene  of  the  workman,  the 
sanitation  of  the  plant  at  which  he  is  employed  and  the  habitation  in 
which  lie  is  honsed.  ( 2 1  That  which  considers  the  adoption  of 
selectiye  measures,  whereby  only  persons  fitted  for  their  work  are  per- 
mitted to  enter  the  employ  of  the  shipyard  and  who,  through  medical 
care,  are  enabled  to  keep  themselyes  in  a  condition  of  bodily  yigor. 

EXAMINATION  OF  WORKERS 

2.  Many  employers  haye  found  it  adyisable  to  determine  the  con- 
dition of  health  of  a  worker  at  the  time  he  enters  the  employ  of  the 
company  and  at  iuteryals  afterwards.  This  procedure  benefits  both 
the  employer  and  the  workman.  Physical  examinations  properly  car- 
ried out  will  bring  to  the  attention  of  the  examining  physician  any 
communicable  disease  with  which  the  applicant  might  be  afflicted  and 
which  might  be  communicated  to  his  fellow-workmen.  Applicants  for 
employment  sutferiug  from  minor  ailments  or  condition  of  ill  health 
should  not  necessarily  be  excluded  from  emi)loyment,  but  should  be 
given  work  for  which  they  are  best  suited. 

Physical  examination  of  workers  provides  also  for  the  early  de- 
tection of  conditions  which,  untreated,  might  become  serious,  and  the 
examiner  is  given  the  opportunity  to  indicate  to  those  persons  in  which 
these  conditions  are  found  the  remedy  which  will  restore  them  to  a 
condition  of  health. 

Whenever  physical  examinations  are  carried  on  it  is  advisable  to 
provide  and  maintain  especially  arranged  quarters  for  this  purjiose. 
Such  arrangement  should  include  individual  dressing  rooms  for  appli- 
cants and  other  facilities  necessary  for  the  i)roper  conduct  of  this 
work. 

The  Department  of  Ilealtli  and  Sanitation  will  upon  recpiest  send 
to  yard  authorities  a  floor  jilau  showing  the  convenient  arrangement 
of  rooms  and  facilities  for  the  proper  carrying  out  of  ])hysical  exami- 
nations in  an  industrial  establishment.  The  adoption  of  the  following 
examination  form  is  strongly  recommended,  which  should  be  i)rinted 
on  an  S  l»y  10t4-inch  card  and  ruled  conveniently:  ' 


CORPORATION 
PHYSICAL  EXAMINATION  FOR  EMPLOYMENT 


Name 
Check  Xo. 
Xationality 


Address 

Dept. 

Color 


Date 
Age 


CHECK  ITEMS  APPLICANT  HAS  HAD 


MEDICAL  HLSTUKY 


Scarlet  Fever,  Diphtheria,  Typlioid,  Malaria,  Pneu- 
monia,Tonsilitis,  Rupture,  Asthma,  Habitual  Cough, 
Pleurisy,  Spitting  of  Blood,  Dizziness,  Epilepsy, 
Paralysis,  Discharge  of  Bladder,  Kidney  Disease, 
Syphilis,  Gonorrhea,  Cancer. 

Remarks: 


GENERAL  EXAMIX ATIOX  Height 


AVeight 


EYES 

Vision  Distance 

20  ft. 
Eye  Diseases 

Right          Vision  Distance     Right 
Left                       1  ft.               Left 

EARS 
NOSE 

Hear  Watch  Tick 

Right 
Left 

ft.            Disease 
ft. 

THROAT 

TONGUE 

TEETH 

XECK 

SKIN 

Identification  Marks 

Disease 

CIRCULATION 

Blood  Examination  if  necessary 

Blood  Pressure 

HEART 

Defects 

Compensation 

CHEST 

Girth 

Full  Insp. 

Full  Exp 

LUNGS 

Right 

Left 

ABDOMEN- 

-Girth 

Stomach 

Liver 

INGUINAL 

REGION 

Intestines 

Kidneys 

Bladder 

GENATALIA 

URINE 

Color        React. 

Sp.  (irav. 

Albumin         Sugar 

SEVERE  INJURIES  OR  OPERATIONS 
NERVOUS  SYSTEM 
GENERAL  INTELLIGENCE 
ALCOHOLISM  OR  DRUG  HABITS 


ACCEPTED 
RECOMMENDED  FOR 


REJECTED 


Examining  Physician 


DISEASES 

COMMUNICABLE  DISEASE 

o.  The  iiiauajiemeiit  of  the  shipvanl  should  laiiiiliai-ize  ilsell'  with 
the  regulations  of  the  local  and  State  healtli  authorities  which  con- 
cern the  control  of  communicable  disease,  that  no  employee  wlio  has 
been  ill  with  communicable  disease  shall  return  to  his  w<»rk  until  the 
danger  of  convovinji'  infection  lias  passed. 

VENEREAL  DISEASE 

4.  The  Department  of  Health  and  Sanitation  is  prepared  to  give 
active  assistance  to  any  shipyard  management  desiring  to  control  the 
prevalence  of  venereal  disease  among  their  employees.  An  mquiry  into 
the  amount  of  disal)llity  duo  to  venereal  disease  shouhl  ]»rompt  em- 
ployers of  lal)or  at  shipyards  to  take  all  possible  means  to  minimize 
the  appearance  of  these  diseases  among  their  employees. 

VACCINATION  FOR  SMALLPOX  AND  TYPHOID 

5.  Compulsory  vaccination  for  smallpox  and  optional  vaccina- 
tion for  typhoid  and  para-typhoid  should  be  carried  out.  Typhoid  vac- 
cine can  be  secured  from  the  Army  Medical  School,  Washington.  D.  C, 
at"  five  cents  a  cubic  centimeter,  and  should  be  ordered  direct. 

MEDICAL  TREATMENT 

6.  The  neglect  of  minor  ailments  l>y  workmen  often  leads  to  pro- 
tracted sickness.  In  yards  having  a  full-time  physician,  or  where  a 
physician  regularly  visits  the  yard,  the  worker  should  be  given  the 
opportunity  to  bring  his  ailment  to  the  physician's  attention.  Im- 
mediate attention  given  these  ailments  should  result  in  the  saving  of 
many  working  hours  otherwise  lost. 

PREVENTION  OF  INFECTION 

7.  Workmen  should  be  reipiired  to  report  for  treatment  all  abra- 
sions, cuts  and  scratches,  no  matter  how  slight.  Too  great  stress 
cannot  be  placed  upon  the  necessity  of  keeping  infected  hands,  hand- 
kerchiefs and  mouth  away  from  wounds  and  abrasions.  Injured  per- 
sons should  be  taken  to  First  Aid  Station  without  touching  wound 
unless  bleeding  is  dangerous  to  life!  Much  unnecessaiw  illness  and 
loss  of  time  can  l)e  jirevented  by  the  immediate  treatment  of  injuries, 
whether  serious  or  slight.  The  passage  of  infection  and  ccuitagion 
from  one  person  to  another  can  l)e  largely  ]>revented  liy  the  installation 
of  sanitary  toilets,  lavatories  and  drinking  fountains. 

TREATMENT  OF  WOUNDS 

8.  The  surgical  treatment  of  wounds  with  Dichloramine-T  and 
Chlorcosane  to  prevent  and  remove  infection  and  reduce  the  period  of 
disability  is  strongly  recommended.  Technic  outlined  by  Dr.--Edward 
Martin,  of  Philadeliihia.  is  given  in  Appendix  "A." 


STAFF 

The  following  are  coussidered  ininiiiiuni  lequirenients  tor  the 
proper  treatment  and  care  of  employees  in  the  shipyard  plants. 

FIRST  AID  ATTENDANTS  AND  DOCTORS  ON  CALL 

9.  Plants  employing  under  one  thousand  men  should  have  a 
first  aid  attendant  or  trained  nurse  for  each  shift  and  two  doctors  on 
call.  First  aid  attendant  should  have  taken  a  regular  course  in  First 
Aid,  and  should  have  passed  examination  in  same  satisfactory  to 
attending  doctor. 

RESIDENT  PHYSICIAN 

10.  In  plants  emplojiug  over  one  thousand  men  a  resident  physi- 
cian should  be  employed  and  should  be  furnished  with  such  assistance 
as  the  size  of  the  plant  and  work  to  be  done  demands.  In  plants 
where  a  dispensary  is  required  it  is  desirable  to  have  a  physician  resi- 
dent in  the  dispensary.  Plant  physicians  must  have  a  license  to  prac- 
tice medicine  in  the  State  in  which  the  plant  is  located. 

First  aid  treatments  may  be  rendered  by  nurses  or  attendants. 
All  redressings  should  be  overseen  by  licensed  jthysician  and  first  aid 
treatment  should  be  whenever  possible. 

TREATMENT  FACILITIES 
Three  types  of  facilities  for  the  treatment  of  injuries  and  illness 
at  shipyards  are  discussed  in  this  bulletin : 

FIRST  AID  STATION 

11.  The  First  Aid  Station  is  the  unit  recommended  for  plants 
employing  up  to  one  thousand  men.  In  no  case  should  first  aid 
treatment  be  given  in  the  yard  office.  A  specially  assigned  room 
should  always  be  provided  for  first  aid  treatment. 

DISPENSARY 

12.  A  dispensary  is  necessary  for  plants  employing  from  1,000 
to  2,500  men.  A  First  Aid  Station  located  at  a  convenient  point 
within  the  grounds  should  supplement  the  dispensary  for  each  2,500 
men  employed. 

HOSPITAL 

13.  The  need  of  a  i)lant  hospital  depends  largely  upon  available 
hospital  facilities  in  the  vicinity.  A  plant  employing  a  relatively  small 
number  of  men,  and  in  a  situation  remote  from  adequate  hospital 
facilities  w^ould  be  much  more  dependent  upon  its  own  resources  than 
a  plant  employing  many  more  men,  but  with  nearby  hospital  facilities 
immediately  available.  With  this  consideration  in  mind  each  plant 
should  make  adequate  provision  for  the  hospital  care  of  its  injured 
employees. 

10 


STRETCHERS 

14.  Stretchers  should  he  jtlaced  in  various  j»arts  of  the  yard  to 
insure  the  rapid  renu)val  and  innuediate  care  of  the  injured. 

AMBULANCE 

15.  Plants  should  own  or  have  at  their  dis]»osal  a  sufficient  num- 
ber of  ambulances  to  insure  quick  transportation  of  patients  to  dis- 
pensary or  hos])ital. 

HEAT  PROSTRATION 

IG.  Arrangements  should  be  made  on  or  near  the  shipways  in 
advance  for  the  treatment  of  heat  prostration.  A  tent  with  tiy  in 
which  is  kept  a  tub  of  cold  water,  ice,  etc.,  is  recommende<l.  Tent 
should  open  at  both  ends  and  have  sides  that  roll  up.  Several  of  these 
should  be  provided  in  the  larger  yards.  This  a] (plies  to  yards  located 
in  parts  of  the  country  where  heat  prostration  occurs. 

MUNICIPAL  AND  PRIVATE  HOSPITALS 

17.  It  is  extremely  important  that  definite  arrangements  be  made 
in  advance  with  the  hospital  management  as  to  available  accommoda- 
tions and  charges  for  same.  Arrangements  should  also  be  made  with 
members  of  the  staff  in  regard  to  charges  to  be  made  for  standard 
operations  and  treatments. 


FIRST   AID  STATIONS 
LOCATION 

IS.  First  Aid  Stations  should  be  placed  in  existing  buildings 
whenever  possible  and  when  not  possible,  small  stations  should  be 
constructed  and  centrally  located  for  this  purpose.  One  of  these 
stations  should  be  e(iui{>ped  with  resuscitating  apjiaratus,  and  one  or 
more  such  pieces  of  api>aratus  should  be  close  to  the  shipways.  Several 
men  should  be  available  who  have  been  trained  in  the  jtrone-pressure 
method  of  resuscitation. 

PLANS 

1*J.  First  Aid  Stations  with  two  rooms  and  with  four  rooms  are 
described.  The  two-room  station  combines  the  waiting  with  the  office 
and  record  rooms,  and  the  emergency  with  the  dressing  room,  shown 
in  plans  for  four-room  stations.  The  two-room  station  is  recommended 
for  plants  employing  from  L*()(»  to  500  men;  the  four-room  station 
for  plants  employing  500  to  1,000  men.  The  equijiment  of  the  two- 
room  station  shouhl  include  as  much  as  space  will  ixMinit-'Of  that 
outlined  for  the  four-room  station. 

11 


The   following   floor   plans    are   recommended   for   the   four-room 
station : 

/^-/RS-T  A/O  STAT/ ON 

0£fT  0/=^  HSy^LTH AA/O  SAA//TATfON 


EQUIPMENT 

20.  The  following  eiinlpment  is  snggested  as  the  miuimnm  de- 
sired :  Waiting  room  should  contain  eight  chairs  or  efpiivalent,  wash 
bowl  and  closet  for  stretchers.  Attendant's  supply  room  and  office 
should  contain  one  desk,  one  wardrobe,  two  chairs,  one  tiling  cabinet, 
one  typewriter  with  stand  and  adequate  shelving  for  supplies.  Emer- 
gency room  should  contain  one  toilet,  one  bed,  one  examining  table 
and  one  glass-top  stand.  Treatment  room  should  contain  two  di'ess- 
ing  tables,  one  lavatory  or  sink,  one  small  sterilizer,  one  cabinet,  one 
three-basin  stand,  one  sanitary  waste  can,  two  small  glass-top  tables, 
three  chairs  and  two  stools. 

SUPPLIES 

21.  A  list  of  instruments,  dressings,  drugs  and  other  supplies 
that  are  considered  adequate  will  be  furnished  on  application. 


12 


<»■%  k\-i-\ 


DISPENSARY 

LOCATION 

i!2.  The  building  in  which  the  dispensary  is  located  should  be 
inside  the  yard  and  of  convenient  access.  Where  plants  make  physical 
examinations  of  their  employees,  a  dispensary  should  be  conveniently 
located  with  reference  to  the  service  or  em[doyment  department  of  the 
plant. 

PLANS 

23.  The  dispensary  should  contain  adecjuate  facilities  for  first 
aid  and  emergency  work  and  should,  in  general,  include  the  provisions 
shown  in  the  following  diagram : 

EQUIPMENT 

24.  The  completeness  of  disi)ensary  equipment  should  be  gov- 
erned considerably  by  available  hospital  accommodations. 

The  physical  examination  section  should  consist  of  a  waiting 
room,  a  toilet  room,  wdth  wash  bowl,  six  to  ten  dressing  booths,  two 
shower  baths,  an  examining  room,  and  a  physician's  living  room  with 
bath  adjoining.  The  dispensary  proper  should  include  a  waiting  room, 
a  physician's  office,  a  ward  of  from  two  to  ten  beds,  a  diet  kitchen,  if 
patients  are  to  be  retained  in  the  ward,  a  bath  room  for  patients,  a 
clerk's  record  and  supply  room,  a  treatment  room,  a  preparation  room, 
an  operating  room,  an  X-ray  room  and  a  dark  room.  The  complete 
equipment  recommended  for  any  or  all  of  the  above  rooms  will  be 
furnished  upon  request  to  the  Department  of  Health  and  Sanitation. 

SUPPLIES 

25.  Complete  drug,  dressing  and  laboratory  sui»ply  lists  will  be 
furnished  upon  re(iuest  to  the  Department  of  Health  and  Sanitation. 


YARD  HOSPITAL 
LOCATION. 

26.  Whenever  it  is  considered  necessary  to  build  hospitals  they 
should  be  located  outside  of  the  plants. 

PLANS  AND  EQUIPMENT 

27.  Plans  for  hosjiitals  of  all  sizes  can  be  furnished  by  the 
Department  of  Health  and  Sanitation,  as  well  as  complete  lists  of 
equipment  needed  and  estimate  on  cost  of  the  same.  Sample  plans 
of  hospital  already  constructed  are  available. 


13 


DISPENSARY 
LOCATION 

L'l'.  The  hiiildiii^  in  whicli  the  dispensary  is  located  should  be 
inside  the  yard  and  of  convenient  access.  Where  plants  make  physical 
examinations  of  their  emjiloyees,  a  dispensary  should  be  conveniently 
located  with  reference  to  the  service  or  employment  department  of  the 
plant. 

PLANS 

2o.  The  dispensary  should  contain  adequate  facilities  for  first 
aid  and  emergency  work  and  should,  in  general,  include  the  provisions 
shown  in  the  following  diagram : 

EQUIPMENT 

24.  The  completeness  of  dispensary  equipment  should  be  gov- 
erned considerably  by  available  hospital  accommodations. 

The  physical  examination  section  should  consist  of  a  waiting 
room,  a  toilet  room,  with  wash  bowl,  six  to  ten  dressing  booths,  two 
shower  baths,  an  examining  room,  and  a  physician's  living  room  with 
bath  adjoining.  The  dispensary  proper  should  include  a  waiting  room, 
a  physician's  office,  a  ward  of  from  two  to  ten  beds,  a  diet  kitchen,  if 
patients  are  to  be  retained  in  the  ward,  a  bath  room  for  patients,  a 
clerk's  record  and  supply  room,  a  treatment  room,  a  preparation  room, 
an  operating  room,  an  X-ray  room  and  a  dark  room.  The  complete 
equipment  recommended  for  any  or  all  of  the  above  rooms  will  be 
furnished  upon  request  to  the  Department  of  Health  and  Sanitation. 

SUPPLIES 

25.  Complete  drug,  dressing  and  laboratory  supply  lists  will  be 
furnished  upon  reijuest  to  the  Department  of  Health  and  Sanitation. 


YARD  HOSPITAL 
LOCATION 

20.  Whenever  it  is  considered  necessary  to  build  hospitals  they 
should  be  located  outside  of  the  plants. 

PLANS  AND  EQUIPMENT 

27.  Plans  for  hospitals  of  all  sizes  can  be  furnished  by  the 
Department  of  Health  and  Sanitation,  as  well  as  complete  lists  of 
equii>ment  needed  and  estimate  on  cost  of  the  same.  Sample  ]>lans 
of  hospital  already  constructed  are  available. 


13 


SANITATION 

WATER  SUPPLY 
An    ample    supply    of    clean    pure    water    properly    distributed 
throughout  the  yard  for  drinking  and  washing  purposes  is  absolutely 
essential  to  the  maintenance  of  health. 

SOURCE 

28.  Surface  water  from  streams  or  lakes  should  never  be  used 
without  thorough  purification,  except  from  uninhabited  drainage  areas. 
When  shipyards  are  near  a  town  or  city  having  a  water  supply  ©f 
established  purity,  and  it  is  practical  to  obtain  connections  from  the 
public  mains,  it  is  advisable  to  do  so.  Where  it  is  necessary  for  the 
yard  to  provide  a  new  or  additional  water  supply,  local  conditions 
will  govern  the  selection  of  the  best  source,  and  upon  request  the 
Department  of  Health  and  Sanitation  will  furnish  advice  as  to  the  best 
and  most  economical  procedure  to  be  adopted. 

If  shallow  wells  are  used  as  the  source  of  water  supply  a  location 
should  be  selected  where  there  is  a  positive  assurance  that  there  is  no 
danger  of  soil  or  surface  contamination  within  influence  upon  the 
well.  The  upper  part  of  the  well  should  be  lined  with  tight  walls 
which  should  be  carried  above  the  surface  of  the  ground,  Avhich  should 
be  graded  to  carry  surface  water  away  from  the  well.  The  well  should 
be  protected  with  a  water-tight  cover. 

If  artesian  wells  are  used,  they  should  be  driven  to  a  sufficient 
depth  to  insure  a  supply  of  uncontaminated  ground  water.  Artesian 
wells  may  become  contaminated  through  soil  pollution  of  the  drift 
overlying  the  water-bearing  rock,  or  by  pollution  entering  the  well 
along  the  exterior  surface  of  the  well-casing.  These  conditions  should 
be  protected  against  in  an  adequate  manner. 

If  purified  water  from  streams  or  lakes  be  determined  upon  as 
the  source  of  water  supply,  the  Department  of  Health  and  Sanitation 
will  furnish  advice  upon  request,  as  to  the  best  type  of  purification 
plant  to  install  in  each  particular  instance. 

QUALITY 

29.  The  water  should  at  all  times  be  free  from  contamination 
(presence  of  disease  germs),  pollution  (presence  of  organic  matter), 
or  not  contain  an  undue  amount  of  mineral  matter  ( such  as  "hard- 
ness," sulphur,  iron  or  mineral  salts). 

This  condition  may  be  obtained  by  selection  of  a  projter  source 
of  supply  and  exercising  eternal  vigilance  in  every  process  of  purifica- 
tion used  and  in  piping  the  water  direct  to  the  point  where  it  is 
actually  used. 

The  quality  of  the  water  should  be  determined  at  regular  intervals 
by  bacteriological  and  chemical  analyses  made  by  reputalde  laVtora- 
tories. 

14 


Ill  many  cases  state  or  local  Boards  of  Health  are  able  to  do 
this  work.  Copies  of  analyses  should  be  sent  to  the  Department  of 
Health  and  Sanitation  of  the  United  States  Slii])])iii<i-  Hoard  Emer- 
gency Fleet  Corporation. 

The  water  should  also  be  clear  and  cool  and  without  taste  or  odor. 

Industrial  or  fire  protection  water,  not  of  drinking  water  quality, 
should  not  be  used  for  washing  purposes,  for  experience  has  clearly 
demonstrated  that  warning  notices  do  not  deter  thirsty  men  from 
drinking  such  water. 

PRESSURE 

30.  By  means  of  pumping  to  a  standpipe  or  elevated  tank  and 
the  use  of  amply  large  i)iping,  a  pressure  sufficient  to  deliver  water 
to  the  highest  parts  of  the  yard  and  building  should  be  maintained. 

DISTRIBUTION 

•'U.  No  matter  how  much  care  is  exercised  in  obtaining  a  pure 
water  supply,  if  it  is  not  properly  distributed  to  the  workmen  the 
expense  of  purifying  the  water  is  wasted.  The  real  test  of  purity  is 
the  quality  of  water  actually  drunk  and,  therefore,  the  water  should 
never  be  exposed  in  open  containers  in  such  a  manner  as  to  become 
contaminated. 

The  distribution  of  water  by  bucket  and  common  drinking  cup  is 
insanitary  and  one  of  the  most  direct  means  for  transmission  of 
disease.  This  method  should  not  be  permitted  in  the  shipyards.  The 
water  supply  should  be  distributed  through  a  system  of  pipes  and 
bubbling  fountains  of  approved  type  installed  at  frequent  and  con- 
venient locations  about  the  yard.  The  fountains  should  have  an  in- 
clined jet  so  that  the  water  does  not  fall  back  on  itself  and  provided 
with  a  housing  to  prevent  the  lips  of  the  drinker  from  touching  the 
outlet  pipe. 

At  such  times  or  in  such  ])laces  where  drinking  water  must  be 
carried  to  the  workmen  a  closed  container,  ])rovided  with  a  closed  lid 
and  a  spout,  should  be  used  and  the  men  supjdied  with  individual  tlat 
paper  cups. 

In  those  yards,  where  in  summer  the  water  would  be  warm  and 
unpalatable,  there  should  be  provided  immediately  before  each  bubbler 
a  coil  in  the  Avater  i)ipe,  on  which  ice  should  be  kept  in  a  suitable 
])rotected  box.  Such  fountains  should  be  provided  with  a  self-closing 
valve  or  foot  lever  to  avoid  Avaste  of  cooled  water. 

DUAL  CONNECTIONS 

;>2.  As  the  i)urity  of  the  water  sujqdy  is  absolutely  essential  to 
health,  there  should  not  be  any  connection  between  the  mains^or  pii)es 
carrying  drinking  water  and  those  carrying  nni)uritie<l  water  used 
for  industrial   j)urposes  or  for  fire  protection. 

15 


In  case  imii.siial  conditious  iudicate  necessity  for  dual  connections 
and  if  such  be  authorized  by  the  Department  of  Health  and  Sanitation 
and  approved  by  local  and  state  health  officials  having  lawful  juris- 
diction in  the  premises  the  same  shall  consist  of  two  check  valves,  three 
pressure  gauges  and  two  blow-offs,  installed  in  a  manhole  of  ample 
size  for  convenient  operation  provided  with  a  drain  to  carry  away 
water  blown  off  during  tests. 

The  specifications  for  these  check  valves  must  require  the  seat 
ring,  disc,  holding  ring  and  screws,  disc  stud,  arm  hinge  pin  and  bush- 
ings to  be  of  bronze;  disc  to  be  faced  with  medium  hard  rubber,  and 
that  liberal  clearances  shall  be  left  around  clapper  and  arm  in  all 
positions. 

This  type  of  "fire  service  connection"  is  shown  in  diagrammatic 
illustration.  Normally,  indicator  post  gate  valves  M  ancFrx  are  open 
and  test  valves  D  and  E  are  closed.  At  monthly  intervals  a  test 
should  be  made  of  the  tightness  of  the  check  valves,  and  at  intervals 
of  about  three  months  the  bonnets  of  the  check  valves  should  be 
removed  and  the  checks  and  their  bearing  seats  carefully  cleaned.  To 
facilitate  removal  of  bonnets,  manilla  paper  packing,  soaked  in  ma- 
chine oil,  should  be  used  and  bolts  greased  with  heavy  oil  and  graphite. 
To  make  test  of  lightness  of  check  valves,  close  valve  M  and  open 
valve  D.  Pressure  on  gauge  A  should  fall  to  zero  and  on  gauge  B 
hold.  Valve  E  should  now  be  opened  and  pressure  on  gauge  B  should 
fall  to  zero  and  on  gauge  C  hold.  The  principle  of  this  test  will  be 
clearly  seen  by  examining  figure  3  of  the  drawing.  After  test  is  com- 
pleted valves  M  and  N  must  be  left  open  to  permit  flow  through  the 
connection. 
GENERAL  TOILETS 

33.  The  exposure  of  fecal  matter  has  repeatedly  resulted  in  the 
development  of  typhoid  fever  and  kindred  diseases  through  the  direct 
transmission  by  flies  of  intestinal  disease  germs  to  food  stuffs.  Sani- 
tary means  for  the  disposal  of  the  excreta  of  the  workers  at  the 
shipyard  are  essential  for  health,  comfort  and  decency.  Suitable 
toilets  should,  therefore,  be  provided  at  convenient  locations  in  the 
yard  and  connected  with  a  sewer  system. 

At  least  one  seat  or  water  closet  should  be  juovided  for  each  25 
workers. 

Urinals  should  be  provided  in  a  ratio  of  one  for  each  40  workers. 
Two  feet  of  wall  or  trough  urinals  shall  be  considered  as  equivalent 
to  one  urinal. 

It  is  most  important  that  toilets  should  be  kept  clean.  A  janitor 
or  other  employee  should  be  definitely  assigned  for  this  purpose  and 
held  responsible  for  their  maintenance. 

Compound  solution  of  cresol  (as  described  under  "Cleaning  and 
Disinfectants'')  should  be  used  in  cleaning. 

16 


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WATER  CLOSETS  AND  URINALS 

154.  In  toilets  con  tain  in  j;'  A\ait'i-  closcis  and  niiiials  ihcrc  should 
be  at  least  10  square  feet  of  Hooi-  space  and  (i<i  cubic  leel  of  aii-  space 
per  seat  or  urinal.  Ventilation  should  he  direct  to  the  outside  air  hv 
windows  or  other  suitable  openinjis.  ]»ro])erly  screened.  Natural  light 
should  be  ample  so  that  all  ]iarts  »»f  the  toilet  are  easily  visible.  The 
floors  and  side  walls  lor  a  height  of  at  least  12  inches  should  be  con- 
structed of  materials  impervious  to  moisture  and  should  have  a 
smooth  surface.  Wood  is  not  a  satisfactory  material.  The  seats 
should  be  of  the  open  front  type  as  a  protection  against  transmission 
of  venereal  diseases.  Urinals  should  be  made  of  non-corrosive  ma- 
terials.    If  of  metal  they  should  be  lined  with  enamel. 

PRIVIES 

35.  If  conditions  are  such  that,  in  the  opinion  cd'  the  Department 
of  Health  and  Sanitation,  privies  may  be  considered,  the  following 
general  principles  shall  be  used,  but  it  is  distinctly  stated  that  privies 
are  considered  as  temporary  exi)edients  only  and  should  as  soon  as 
possible  be  abandoned. 

Greatest  care  must  be  exercised  that  privies  shall  never  be  located 
within  influence  upon  any  source  of  water  sujtjdy.  They  should  also 
be  located  as  far  as  practicable  from  any  ]dace  where  food  is  stored, 
prepared,  exposed  for  sale  or  eaten. 

They  should  be  so  constructed  and  maintained  that  they  will  Ise 
cleanly,  prevent  fly-breeding  or  fly-transmission  of  disease,  pollution 
of  sources  of  water  supplies,  development  of  odors  or  any  other  in- 
sanitary condition  or  nuisance.  Privies  containing  seats  should  also 
always  be  provided  with  urinals,  as  it  is  practically  im])ossible  to 
maintain  clean  seats  otherwise. 

The  attached  drawings  are  suggested  for  jiiivies  where  they  are 
allowed. 

SEWAGE  DISPOSAL 

oG.  When  excreta  from  t(d]ets  or  wastes  from  sinks,  etc.,  are 
carried  away  by  the  spent  water  supply  in  sewers,  jxjllution  of  the 
receiving  body  of  water  will  be  caused  unless  proper  means  for  sewage 
disposal  are  adopted.  This  may  cause  local  nuisance  or  endanger 
water  supplies  or  shell-fish  beds,  according  to  local  conditicms.  Most 
states  have  legislation  controlling  dis]»osal  of  sewage  wliicli  iiiusi  be 
complied  with.  The  Dejiartment  of  Health  and  Sanitation  will,  upon 
request,  advise  as  to  proper  ]»rocedure  in  eacii  s|iecilic  instance. 

WASH  ROOMS 
37.     A   suitable  room  for  washing  should   l)e  ]/rovided   for  em- 
ployees.    If  practical  it  is  desirable  that  this  privilege  should  be  ex- 
tended to  all,  but  it  is  only  justice  and  in  the  interest  of  self-respect 

17 


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WATER  CLOSETS  AND  URINALS 

oJ:.  lu  toilets  coiitaiiHii<j;-  waler  closets  and  ui-iiials  there  should 
be  at  least  10  square  feet  of  floor  space  and  60  cubic  feet  of  air  space 
per  seat  or  urinal.  \'entilatioii  should  be  direct  to  the  outside  air  by 
windows  or  other  suitable  openiugs.  properly  screened.  Natural  light 
should  he  ample  so  that  all  parts  of  the  toilet  are  easily  visible.  The 
floors  and  side  walls  for  a  height  of  at  least  12  inches  should  be  con- 
structed of  materials  impervious  to  moisture  and  should  have  a 
smooth  surface.  Wood  is  not  a  satisfactory  material.  The  seats 
should  be  of  the  open  front  type  as  a  protection  against  transmission 
of  venereal  diseases.  Urinals  should  be  made  of  non-corrosive  ma- 
terials.    If  of  metal  they  should  be  lined  with  enamel. 

PRIVIES 

35.  If  conditions  are  such  that,  in  the  opinion  of  the  Department 
of  Health  and  Sanitation,  privies  may  be  considered,  the  following 
general  principles  shall  be  used,  but  it  is  distinctly  stated  that  privies 
are  considered  as  temporary  expedients  only  and  should  as  soon  as 
possible  be  abandoned. 

Greatest  care  must  be  exercised  that  privies  shall  never  be  located 
within  influence  upon  any  source  of  water  sui)ply.  They  should  also 
be  located  as  far  as  practicable  from  any  place  where  food  is  stored, 
prepared,  exposed  for  sale  or  eaten. 

They  should  be  so  constructed  and  maintained  that  they  will  be 
cleanly,  prevent  fly-breeding  or  fly-transmission  of  disease,  pollution 
of  sources  of  water  supplies,  development  of  odors  or  any  other  in- 
sanitary condition  or  nuisance.  Privies  containing  seats  should  also 
always  be  provided  with  urinals,  as  it  is  practically  imjwssible  to 
maintain  clean  seats  otherwise. 

The  attached  drawings  are  suggested  for  ](rivies  where  they  are 
allowed. 

SEWAGE  DISPOSAL 

30.  When  excreta  from  toilets  or  wastes  from  sinks,  etc.,  are 
carried  away  by  the  spent  water  supply  in  sewers,  i)ollutIon  of  the 
receiving  body  of  water  will  be  caused  unless  projier  means  for  sewage 
disposal  are  adoi)ted.  This  may  cause  local  nuisance  or  endanger 
water  sufiplies  or  shell-fish  beds,  according  to  local  conditions.  Most 
states  have  legislation  controlling-  disposal  of  sewage  which  must  be 
complied  with.  The  Department  of  Heallh  and  Sanilalion  will,  upon 
request,  advise  as  to  ])roper  procedure  in  each  specitic  inslance. 

WASH  ROOMS 
37.     A   suitable  room  for  washing  should   be  provided   for  em- 
ployees.    If  practical  it  is  desirable  that  this  i)rivilege  should  be  ex- 
tended to  all.  but  it  is  only  justice  and  in  the  interest  of  self-respect 

17 


that  emploj'ees  engaged  in   work  causing  them   to  become  hegiimed 
should  not  be  required  to  travel  to  their  homes  in  that  condition. 
If  body  bathing  be  provided  for,  shower  baths  are  preferable. 

DRESSING  ROOMS 

38.  Facilities  should  be  provided  for  employees  to  change  and 
store  their  clothing.  Employees  exposed  to  extremes  of  temjjerature  or 
whose  work  causes  them  to  become  dirty,  are  entitled  to  these  con- 
veniences, as  necessities  for  healthful  and  decent  living. 

Lockers  should  be  of  substantial  construction,  preferably  of  steel, 
with  provisions  for  ventilation  and  having  a  sloping  to]»  to  prevent 
accumulating  rubbish.  They  should  be  at  least  twelve  inches  by  fifteen 
inches  in  plan,  and  four  feet  six  inches  in  height,  nundjered  and 
provided  with  locks.  Low  benches  should  be  provided  to  aft'ord  con- 
venience in  changing  shoes. 

Workers  should  be  required  to  keep  the  lockers  in  a  clean  con- 
dition, but  a  janitor  or  other  designated  employee  should  be  given 
charge  of  the  dressing  room  and  held  responsible  for  the  maintenance 
of  entire  room  in  a  clean  condition. 

Some  establishments  have  met  their  locker  problem  by  the  use 
of  wire  baskets  raised  to  and  lowered  from  the  ceiling  of  the  dressing 
room  by  a  cord  and  pulley  arrangement. 

CLEANING  AND  DISINFECTANT 

39.  Eooms  should  be  kept  clean.  The  first  essential  in  order  to 
bring  about  this  condition  is  to  develop  in  the  workers  a  spirit  of 
pride  and  interest  in  their  surroundings  and  a  sense  of  orderliness. 

To  discourage  workers  from  expectorating  on  the  Hoor,  cuspidors 
should  be  provided  and  cleaned  at  frequent  intervals. 

BeTore  floors  are  swept  they  should  be  sprinkled  with  moistened 
sawdust  to  lay  the  dust. 

Where  ordinary  cleaning  should  be  followed  by  a  disinfectant,  a 
three  or  four  per  cent,  solution  in  water  of  liquor  cresoils  comi»ound 
(commonly  called  compound  solution  of  cresol )  should  be  used.  This 
consists  of  a  saponified  solution  of  cresol.  It  is  not  a  proprietary 
article,  although  often  sold  under  various  trade  names. 

GARBAGE  DISPOSAL 

40.  The  garbage  from  shipyards  will  \)v  dciivcd  ]>iiucipaily  from 
the  restaurant  or  lunch  rooms,  and  from  dwelling  houses  if  they  are 
provided  for  em])loyees  with  families.  It  should  be  collected  in 
covered  impervious  containers  to  avoid  fly-breeding  and  odor  nuisance 
and  collected  at  frequent  intervals. 

If  the  yard  is  near  enough  to  a  town  or  city  haying  municipal 
collection  arrangements  may  be  made  for  disposal  by  municipal  au- 
thorities. 

19 


MANURE  DISPOSAL 

41.  A  stable  ou  or  adjacent  to  the  shipyard  makes  the  sanitary 
care  and  disposition  of  the  manure  a  matter  of  importance  to  prevent 
the  development  of  dies  with  accompaming  danger  of  disease  trans- 
mission by  them.  When  this  condition  is  fonud  outside  the  shipyard, 
the  Department  of  Health  and  Sanitation  will  endeavor  through  proper 
channels  to  cause  abatement  of  the  nuisance. 

Flies  are  bred  in  decomposing  materials,  such  as  manure,  and 
not  only  feed  upon  that  material,  but  also  upon  food  stuffs  for  human 
consumption.  This  direct  connection  is  not  only  revolting  to  the  sense 
of  decency,  but  by  means  of  their  hairy  legs  and  mouth  parts  they 
convey  disease  germs  from  the  excrement  to  the  food. 

Cleanliness  in  stables  is,  therefore,  essential.  The  floors  should 
be  impervious  to  moisture.  The  manure  should  be  frequently  removed 
from  the  stalls  and  kept  in  fly-proof  pits  until  final  disposition.  Such 
a  pit  should  preferably  be  constructed  with  concrete  bottoms  and  side 
walls  and  covered  with  fly-tight  doors,  so  made  as  to  exclude  rain 
water,  but  so  constructed  as  to  facilitate  filling  and  emptying  the  pit. 
Each  time  manure  is  placed  in  the  pit,  it  should  be  sprinkled  with 
a  solution  of  powdered  hellebore  made  with  one-half  pound  of  helle- 
bore in  ten  gallons  of  water  and  applied  in  proportion  of  one  gallon 
per  one  cubic  foot  of  manure;  or  other  approved  insecticide.  Such 
solutions  will  largely  destroy  fly  larvae  in  the  manure,  but  will  not 
injure  its  fertilizing  value. 

The  vessel  in  which  the  hellebore  solution  is  kept  should  be 
covered  to  prevent  horses  drinking  it,  as  it  is  poisonous. 

The  manure  should  be  removed  from  the  pit  at  least  twice  a 
week  in  the  summer  time,  and  may  be  used  as  fertilizer,  preferably 
applying  it  to  land  in  thin  layers.  After  removal,  the  pit  should  be 
thoroughly  cleaned  and  sprinkled  with  the  hellebore  solution  or  other 
approved  insecticide  to  kill  any  eggs  or  larvae  of  flies  remaining 
therein. 

MISCELLANEOUS  REFUSE 

42.  In  the  conduct  of  shipyards  more  or  less  refuse  and  rubbish 
accumulates.  Such  general  refuse  should  be  systematically  collected 
and  disposed  of.  If  by  burning,  at  locations  not  creating  any  fire 
hazard. 

MOSQUITOES  INSECTS 

4:5.  It  is  an  established  fact  that  mosquitoes  are  the  means  of 
transmission  of  malaria,  yellow  fever,  dengue  and  other  diseases.  The 
elimination  of  their  breeding  places  and  their  exclusion  from  buildings 
are,  therefore,  essential  to  maintain  workmen  in  a  state  of  efficiency 
at  shipyards,  where  mosquitoes  are  liable  to  be  present.    While  some- 

20 


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times  breediug  places  aiv  entirely  loeal,  it  is  generally  found  that 
extensive  areas  are  involved  as  tiie  cause  of  the  trouble.  The  Depart- 
ment of  Health  and  ^Sanitation  will  use  its  best  efforts  to  enlist  other 
officials  and  bodies  to  co-operate  in  plans  for  mosquito  elimination  in 
the  territory  about  the  shipyard  and  the  dwellings  of  employees. 

Low  land  on  which  water  collects  in  stagnant  pools  should  be 
filled  in  with  ashes,  earth  excavated  from  adjacent  high  ground,  ma- 
terial dredged  from  in  front  of  the  ways  or  other  suitable  inorganic 
material.    This  materially  minimizes  the  menace. 

^yhere  not  i)ractical  to  fill  in  Ioav  land,  drainage  ditches  should 
be  made  to  carry  the  water  away  or  connected  with  tide  water  to 
induce  currents  in  the  water  in  the  ditches. 

The  surface  of  quiet  water  may  also  be  oiled,  which,  if  done 
efficiently  and  continuously  will  destroy  the  mosquitoes  during  their 
larva  stage.  Sufficient  oil  should  be  applied  to  cover  the  entire  sur- 
face with  a  thin  film.  As  the  oil  is  volatile  it  Avill  disappear  in  a  few 
days  or  wind  may  destroy  its  elficacy.  Frequent  api)lications  of  oil 
are  therefore  necessary. 

No  body  of  water  is  too  small  for  mosquito  breeding.  Street 
ditches  with  flat  or  uneven  bottom  form  favorable  breeding  places 
for  mosquitoes  and  should  be  avoided  where  possible.  Rain  water 
collecting  in  depressions  in  the  ground  or  in  empty  cans,  inlets  to 
sewers,  etc.,  and  water  stored  in  cisterns  or  barrels  all  form  a 
mosquito  menace.  Water  tanks  should  be  protected  with  mosquito- 
tight  covers  or  contents  covered  with  oil. 

To  prevent  mosquitoes  gaining  access  to  buildings  all  doors,  win- 
dows and  other  openings  should  be  thoroughly  screened  with  at  least 
No.  16  (16  meshes  per  inch)  wire  netting,  excepting  where  the  yellow 
fever  mosquito  may  appear  in  which  case  at  least  No.  18  screens 
should  be  used, 

FLIES 

44.  As  has  been  stated  above  under  "stable  refuse,"  the  fly  is  a 
serious  menace  to  health.  It  affords  a  direct  means  of  communication 
from  excrement  and  other  filth  to  food  stuff's. 

The  principal  measure  required  for  fly  elimination  is  cleanliness. 
All  garbage,  manure,  and  other  decomposable  matter  should  be  pro- 
tected from  flies  until  final  disposal  in  a  sanitary  manner. 

Even  where  care  is  exercised  to  prevent  fly  breeding  it  is  ditficult 
to  entirely  eliminate  them  an<l  hence  fly  traps  sliould  be  provided  at 
places  where  they  may  be  found.  The  Dei)artment  of  Health  and 
Sanitation  will,  upon  request,  furnish  information  concerning  methods 
of  making  and  baiting  fly  traps. 

In  cases  where  fly  nuisance  exists  at  sliipyards  and  the  cause 
appears  to  be  on  adjoining  premises,  the  Hepartment  of  Healtli  an<l 

21 


Sanitation  will  use  its  best  efforts  to  effect  an  elimination  of  the 
trouble  by  enlisting  the  interest  of  officials  or  other  bodies. 

RESTAURANTS  AND  LUNCH-ROOMS 

GENERAL  DESIGN 

45.  A  well-lighted  and  ventilated  building  adequately  equipped 
with  necessary  facilities  and  strict  cleanliness  of  operation  are  of 
greatest  importance  in  maintaining  sanitary  conditions  in  restaurants 
and  eating-houses. 

The  building  should  be  located  conveniently  in  or  near  the  ship- 
yard, and  there  should  be  an  abundance  of  natural  light  from  windows 
or  skylights  in  the  dining  rooms  and  kitchen. 

The  rooms  in  which  the  groceries  and  provisions  are  stored  should 
be  well  ventilated,  dry  and  protected  from  vermin  and  there  should 
be  a  sufficient  number  of  shelves  so  that  all  such  material  may  be 
stored  in  an  orderly  manner.  All  food  should  be  securely  protected 
from  dust  and  dirt.  No  one  should  be  permitted  to  live  or  sleej)  in 
a  kitchen  or  dining  room  or  other  room  of  an  eating  place  where 
food  is  prepared,  served  or  stored. 

In  connection  with  all  restaurants,  lavatories  supplied  with  soap 
and  individual  towels  should  be  provided  and  maintained  in  a  sani- 
tary condition  and  all  employees  and  others  who  handle  or  prepare 
food  should  wash  their  hands  and  arms  thoroughly  before  commencing 
Avork  or  after  visiting  the  toilet.  Posters  urging  this  practice  should 
be  conspicuously  displayed  in  all  toilets. 

Cuspidors  for  use  of  workers  and  other  persons  should  be  placed 
wherever  necessary  and  thoroughly  emptied  and  washed  daily  with  a 
disinfectant  solution. 

Convenient  and  adequate  toilet  rooms  should  also  be  provided 
as  described  herein.  These  rooms  should  be  separate  and  apart  from 
rooms  where  food  is  prepared  or  served.  The  floors  should  preferably 
be  of  non-absorbent  material  and  should  be  kept  clean  and  in  a  sani- 
tary condition.  The  toilets  and  sinks  should  be  properly  connected 
to  sewer  pipes  through  trapped  and  ventilated  plumbing  fixtures.  The 
sewage  should  be  disposed  of  in  an  approved  manner  and  not  be  per- 
mitted to  discharge  upon  the  surface  of  the  ground  ov  into  adjoining 
open  ditches.  The  Department  of  Health  and  Sanitation  will  furnish 
advice  and  assistance  regarding  suitable  methods  for  the  disposal  of 
wastes  such  as  sewage,  garbage,  etc. 

HEALTH  OF  FOOD  HANDLERS 

46.  Probably  the  greatest  factor  in  the  spread  of  disease  from 
restaurants  and  eating-houses  is  the  employee  therein  who  is  suffering 
from  a  communicable  disease  or  who  is  a  carrier  of  such  infection. 

22 


For  tliis  reasou.  the  yard  ]»li_vsieiaii  slunild  make  an  inspection  of  each 
such  employee  before  he  commences  work  and  all  persons  affected 
with  any  venereal  disease,  tuberculosis,  yellow  fever,  typhoid  fever, 
dysentery,  or  any  other  infections  or  contaj-ions  disease  should  not  be 
permitted  to  work  at  the  eating  place. 

KITCHEN 

47.  The  kitchen  should  be  given  a  central  location,  if  possible, 
so  that  food  may  be  served  readily  to  wings  on  either  side.  Non- 
absorbent  floors  of  concrete  or  composition  are  most  easily  kept  clean, 
and,  therefore,  should  be  used;  but  wood  floors  may  be  permitted  in 
small  establishments  if  proper  cleanliness  is  exercised. 

Cleanliness  demands  that  there  should  be  an  adequate  su])ply  of 
running  hot  and  cold  water  for  dishwashing  and  general  cleaning  pur- 
poses. Where  a  considerable  number  of  persons  are  to  be  fed  at  one 
time,  mechanical  dishwashing  machines  have  the  advantage  of  reduc- 
ing labor  cost  and  permit  a  more  sanitary  handling  of  dishes,  but  if 
such  equipment  is  not  installed,  the  hand  washing  of  dishes  may  be 
satisfactorily  accomplished  if  proper  facilities  are  provided.  These 
should  include  sinks  having  })roi)er  provision  for  rinsing  and  drying 
the  dishes. 

FOODS 

48.  Great  care  must  be  taken  to  serve  only  whcdesome  food,  as 
many  cases  of  dysentery  and  other  intestinal  disturbances  have  been 
traced  to  spoiled  food.  If  there  is  any  doubt  about  the  condition  of 
meat  or  other  food,  it  should  not  be  served,  but  destroyed. 

Inspected  meats  should  be  purchased,  if  they  can  be  obtained. 
The  Government  annually  sjjcnds  several  millions  of  dollars  to  inspect 
meats,  but,  unfortunately,  all  meats  sold  are  not  so  insi)ected.  Meat 
from  local  slaughterers,  who  do  business  entirely  within  the  state,  is 
not  subject  to  this  inspection. 

Proper  protection  from  tubercular  infection  demands  that  the 
milk  supply  should  be  pasteurized  or  be  obtained  from  coays  which 
have  been  tuberculin-tested  within  a  year  by  a  reliable  veterinarian. 
Tuberculosis  has  been  shown  to  be  transmissible  to  man  through 
milk  infected  with  bovine  tuberculosis  and  septic  sore  throat  and 
di])htheria  have  also  been  traced  to  infected  milk  sup])lies.  Pasteur- 
ization {)rotects  the  consumer  from  such  infection. 

Adequate  jirovision  for  refrigerating  meats,  milk,  and  other  foods 
are  essential.  For  this  i)urpose,  ice  boxes,  provided  with  a  sanitary 
lining,  i)referably  of  enameled  metal,  and  so  located  that  the  ice 
may  be  inserted  without  being  carried  through  the  kitchen,  are  de- 
sirable. These  ice  boxes  should  be  thoroughly  cleai^ed  daily  and  a 
frequent  inspection  made  to  ascertain  the  condition  of  the  food  in 
them. 

23 


All  food  should  be  carefully  protected  from  flies.  Doors,  win- 
dows, and  other  openings  should  be  screened  with  wire,  of  not  less 
than  fourteen  meshes  to  the  inch,  during  the  fly  season.  Screen  doors 
should  be  self-closing  and  all  screening  should  be  maintained  In 
good  condition.  Fly  traps  should  be  placed  where  flies  congregate 
and  should  be  j^roperly  baited  as  referred  to  hereinbefore  under 
"Flies."" 

The  water  supply  should  be  that  used  in  the  yard  for  drinking 
purposes,  as  described  hereinbefore. 

LUNCH-ROOM  FACILITIES 

41).  Lunch-rooms  should  also  be  provided  for  the  convenience 
of  workers  who  bring  their  lunch  with  them.  They  should  conform 
(in  so  far  as  applicable)  to  the  requirements  for  restaurants  given 
above. 

In  southern  yards  the  open-side  type  of  construction  with  o])en- 
ings  screened  is  advisable,  and  in  cold  climates  the  room  should  be 
heated  during  cool  weather. 

Tables  and  benches  should  be  provided  for  the  workers'  comfort. 
The  provision  of  flat-top  stoves  permits  the  workers  to  heat  cofl'ee  or 
other  foods. 

A  janitor,  or  especially  assigned  employee,  should  be  charged 
with  the  responsibility  of  maintaining  the  lunch-room  in  a  clean, 
condition. 

If  a  location  for  the  luncli-room  be  approved  by  the  Advisory 
Engineer  on  Fire  Protection  and  the  Fire  Marshal  it  is  desirable  to 
permit  the  men  to  smoke  there  at  the  lunch  time. 

LUNCH  PERIOD 

50.  In  accordance  with  recognized  ideas  on  fatigue  it  is  advisable 
that  employees  should  have  adeiiuate  time  for  a  lunch  period.  The 
human  body  is  a  highly  organized  machine,  and  the  more  arduous  the 
labor  it  performs  the  greater  need  for  the  rest  period  at  lunch  time  in 
order  that  the  meal  eaten  may  furnish  the  maximum  renewed  strength 
for  continued  work. 

HOUSING 

GENERAL  DESIGN 

51.  In  the  general  design  of  housing  facilities,  whether  hotels, 
cottages  or  barracks,  the  first  consideration  should  be  given  to  health 
and  comfort  of  the  occupants. 

The  standard  of  unit  dimensions  of  sleeping  rooms  should  be  to 
provide  not  less  than  500  cubic  feet  of  air  space,  50  square  feet  of 
floor  si)ace,  5  square  feet  of  window  o])ening  for  each  occupant. 

24 


Slecpiiiji'  i-doiiis  should  lucrcraMy  he  df  a  si/.c  siiitalilc  for  iiol 
nioie  tluiu  two  occupants  and  lie  cMHiipped  with  siiij^le  beds. 

In  and  around  shipyards,  where  mosquitoes  are  a  menace,  all 
windows  and  door  openings  should  be  provided  with  substantial 
screens  of  10  meshes  to  the  inch.  The  porches  of  all  cottages  and 
a  liberal  portion  of  the  porches  of  hotels  and  barracks  should  be 
likewise  screened. 

SANITARY  EQUIPMENT 

52.  The  sanitary  equijiment  should  be  amply  sufficient  for  the 
number  of  occupants  and  installed  in  accordance  with  standard 
plumbing-  methods  and  the  requirements  given  hereinbefore. 


RECREATION  FACILITIES 

53.  In  hotels  and  barracks  a  suitable  assembly  and  recreation 
room  should  be  provided. 

LAUNDRY 

54.  Laundry  facilities  (with  standard  type  eiiuipment)  should 
be  provided  for  all  hotels  and  barracks  where  the  service  of  a  public 
laundry  is  not  available. 

Fre<iuent  airing  of  blankets,  mattresses,  etc.,  is  advisable. 


JANITOR  SERVICE 

55.     The  janitor  and  cleaning  force  should  be.  sufficient  to  kee]) 
all  hotels  and  barracks  clean  and  in  good  order. 


APPROVAL   OF  PLANS 

5().  The  Department  of  Health  and  Sanitati(»n  invites  the  sub- 
mission of  proposed  jjlans  of  housing  facilities  for  its  review  and 
suggestions  relating  to  dimensions,  plans,  water  su]»i»ly.  sanitary 
equipment,  ventilation,  heating  and  lighting,  sewage  and  <lrainage, 
methods  of  maintenance,  and  general  {dan  of  pro]>osed  industrial 
villaues. 


25 


APPENDIX  "A" 

TECHNIC  OF  THE  TREATMENT  OF 

INFECTIONS  AND  INFECTED  WOUNDS 

WITH  DICHLORAMINE-T-CHLORCOSANE 


PREPARED    BY 

DK.  ED^yAKD  MARTIN 

University  of  Pennsylvaxia,  Philadelphia 


THESE  ARE  THE  CHARACTERISTICS   OF  A  GOOD 
SURGICAL  DRESSING: 

1.  It  i8  easily,  quickly  and  painlessly  applied. 

2.  It  is  easily  and  painlessly  removed,  without  causing  bleeding. 

3.  Its  removal  is  not  followed  by  discharge  of  retained  exudates. 

The  following  technic  is  suggested  by  a  group  of  surgeons  who 
have  been  intensively  studying  Dichloramine-T  and  who  have 
clinically  used  it  on  more  than  fifteen  thousand  patients.  The  re- 
sults are  habitually  better  than  those  following  the  use  of  any  other 
antiseptic  agent. 

DICHLORAMINE-T   AND   CHLORCOSANE   ARE   SOLD 
SEPARATELY,  IN  BULK  BY 

The  Abbott  Laboratories,  Chicago,  New  York. 
E.  R.  Squibb  &  Sons,  New  York. 
Monsanto  Chemical  Co.,  St.  Louis. 
Robert  McNeil,  Philadelphia. 
BooTS^  London,  England. 

To  the  surface  of  wounds  to  prevent  sticking  either  Parresined 
Lace-Mesh  (Abbott),  or  wide  meshed,  good  quality  paraffined  mos- 
quito netting  may  be  applied.  The  mosquito  netting  is  cut  in  strips 
two  inches  wide  and  six  inches  long.  Without  removing  the  starch 
or  sizing,  it  is  sterilized ;  is  then  steeped  in  hot  paraffine  wax  (melting 
point  45  degrees  C. ) ,  is  drained  out  so  that  the  meshes  are  open ; 
cooled;  and  wrapped,  six  in  a  ])ackage,  in  sterile,  waxeu  (paraffined) 
paper,  then  in  sterile  gauze  and  so  kept  ready  for  use. 

27 


The  pieliminarv  washing  of  the  skin  is  by  sterile  five  per  cent. 
Castile  t^oap  Solution,  or  sterile  neutral  socliiim  soap  solution. 
(Abbott  1. 

PREPARATION  OF   DICHLORAMINE-T-CHLORCOSANE 
SOLUTION: 

Put  the  Dichloramine-T  in  a  perfectly  dry  mortar  and  add  suf- 
ficient Chlorcosane,  constantly  triturating,  to  form  a  pasty  mess. 
Then  add  the  balance  of  Chlorcosane  (with  constant  stirring)  to 
complete  mixture.  When  this  is  done,  transfer  to  an  amber  colored, 
glass  stoppered  bottle,  occasionally  shaking,  until  a  clear  solution" 
results.    It  is  then  ready  for  use.     (Several  hours). 

Dispense  in  perfcctl/j  dry  dark  amber  bottles,  glass-stoppered 
and  bearing  the  date  of  preparation  on  the  label.  Avoid  exposure 
to  direct  sunlight.  Providing  it  be  kept  in  the  dark,  and  does  not 
come  in  contact  with  anything  except  the  glass  of  the  container  in 
which  it  is  dispensed,  this  solution  may  be  kept  for  two  months. 

If  a  heavy  white  precipitate  has  formed  at  the  bottom  of  the 
bottle,  discard  the  contents,  thoroughly  cleanse  the  bottle  with 
Chloroform,  dry,  and  refill  with  fresh  solution. 

A  slight  precipitate  need  not  be  considered,  but  may  well  be 
removed  by  filtration  through  dry  filter  paper. 

A  chilled  solution  may  become  turbid,  but  clears  on  warming  to 
80  degrees  C. ;  if  the  cloudiness  and  the  deposit  remain  after  this 
heating  it  denotes  a  decomposition  and  loss  of  strength  of  th-e 
Dichloramine. 

Solutions  poured  out  into  open  vessels  for  immediate  use  must 
not  be  returned  to  the  stock  bottle;  nor  should  swabs,  pipettes,  or 
nozzles  be  introduced  into  any  stock  container.  Decomposition  once 
started  progresses  rapidly.  Water  and  an  excess  of  light  or  of  heat 
are  fatal  to  slock  solutions. 

SURFACE  APPLICATION 

The  oily  soluli(»n  max  be  swabbed,  dropped  from  medicine  drop- 
per or  small  bottle,  or  squirted  from  an  all-glass  syringe.  If  a  spray 
be  used  it  must  be  all-glass  and  to  vaporize  the  heavy  oily  solution 
must  be  especially  constructed.    It  is  usually  out  of  order. 

All  these  implements  must  be  strictly  dry  before  being  used  and 
must  be  cleaned  after  use  with  chloroform. 

Eaw  and  granulating  surfaces  treated  by  Dichloramine-T-Chlor- 
cosane  are  covered  with  strips  of  jiarresined  lace-mesh  or  paraffined 
mosquito  netting  overlapping  the  surrounding  sound  skin.  Over 
these  strips  is  placed  a  thin  gauze  dressing  held  in  place  with  as  few 
turns  of  gauze  bandage  as  will  suffice  to  retain  it.  and  make  even 
moderate  pressure. 

28 


DEEP  APPLICATION 

The  solution  may  he  s\\al»l»('(l.  iiouicd.  dropped,  or  in  the  ease 
of  sinuses,  injected  l»y  means  of  an  all-glass  syringe  litted  to  a 
16  F.  soft  iiibliei-  catheter,  oi-  to  a  hmg  glass  ])ii)ette  or  nozzle. 

If  the  wound  be  infected  it  should  be  kei)t  open  by  a  strip  or 
strips  of  parresiued  lace-mesh  or  i)arariiued  niopquito  netting.  This  is 
cut  to  appropriate  width  and  folded  once  cross-wise.  The  angle  made 
by  this  fold  is  pressed  to  the  deepest  part  of  the  wound,  thus  lining 
all  raw  surfaces.  In  the  space  enclosed  by  this  lining  is  loosely 
laid  sterile  gauze,  well  soaked  in  Dichloramine-Chhncosane.  In  this 
way  the  wound  is  kei)t  widely  open  by  a  dressing  which  thoroughly 
drains  and  comes  away  without  causing  pain  or  bleeding. 

All  wounds  call  for: 

(fl)    Cleanliness. 

(&)   An  Abundant  Supply  of  Constantly  CHANciiNG  Blood. 

(c)   Eest. 

(A)   CLEANLINESS 

This  is  most  essential  in  the  deepest  part  of  the  wound,  and  is 
impossible  to  secure  or  maintain  in  the  presence  of  dead  tissue  or 
foreign  bodies. 

A  fresh  wound  (within  six  hours)  is  cleansed  in  the  following 
manner:  It  is  tightly  packed  with  gauze  soaked  in  Dichloramine- 
Chlorcosane;  the  surrounding  skin  is  then  rapidly  and  vigorously 
rubbed  clean  with  gauze  wet  with  sterile  Castile  (or  neutral  sodium 
soaj))  solution.  This,  in  turn  is  scrubbed  away  with  gauze  wet  with 
ether,  a  moment  Is  allowed  for  this  to  evaporate,  when  the  skin  is 
tinally  swabbed  with  Dichloramine-Chlorcosane  and  wiped  dry  again 
with  sterile  gauze. 

The  tight  Dichloramine-Chlorcosane  packing  is  then  removed 
from  the  wound  and  the  latter  is  cleansed  by  swabbing  with  Dichlo- 
ramine-Chlorcosane both  before  and  after  the  removal  of  obvious 
dirt,  and  the  excision  of  badly  bruised  or  dead  tissues. 

Incised  icomids,  after  cleansing,  are  closed  by  w  idely  interrupted 
sutures  going  to  the  depth  of  the  wound,  and  scniiring  ai)itosition  of 
raAv  surfaces  without  suture  tension.  A  blanched  skin  about  a  sutvire 
j)ractically  assui-es  death.     Pressure  Necrosis. 

Contused  and  lacerated,  wounds,  after  (deansing  with  Dichlo- 
ramine-Chlorcosane, and  resection  of  (hnilalized  skin  and  deei>er  tis- 
sues (freely  bleeding  and  clean,  healthy  surfaces  being  the  signs  of 
vitality)  are  also  closed  l»y  widely  placed,  interrui>ted  s\itures  going 
to  the  bottom  of  the  wouiul.  or  by  catgut  layer  sutures. 

29 


Such  woundts  are  closed  only  when  this  can  be  accomplished 
without  tension ;  otherwise  they  are  kept  open  wholly  or  in  part  by 
a  strip  or  strips  of  lace-mesh  or  of  paraffined  mosquito  netting  folded 
crosswise,  the  fold  being  carried  to  the  deepest  part  of  the  wound 
and  the  angle  made  by  it  being  lightly  filled  with  the  gauze  soaked 
in  Dichloramine-Chlorcosane. 

Infections  (boils,  abscesses,  carbuncles,  etc.)  are  treated,  after 
surface  cleansing  with  sterile  soap  suds,  ether  and  Dichloramine- 
Chlorcosane,  by  oi»enings  so  placed  and  so  free  that  more  than  twice 
the  access  deemed  desirable  is  atforded.  (An  infection  treated  by  too 
large  an  incision  is  a  surgical  rarity;  one  treated  by  too  small  a  cut 
is  the  rule ) .  These  incisions  should  not  include  tlexure  creases  of 
the  palm  and  fingers. 

The  cavity  is  then  flushed  with  Dichloramine-Chlorcosane  and 
drainage  provided  by  means  of  folded  strips  of  parresined  lace-mesh, 
or  of  paraffined  mosquito  netting,  carried  to  the  deepest  part  of  the 
wound,  the  folds  being  lightly  filled  with  gauze  soaked  in  Dichlora- 
mine-Chlorcosane. 

Large  granulatin<j  surfaces,  as  from  burns.  The  whole  surface 
sprayed  or  swabbed  or  irrigated  with  Dichloramine-Chlorcosane. 
Then  overlapped  by  a  double  layer  of  paraffined  mosquito  netting. 
Over  this  an  absorbing  dressing  of  gauze.  Moderate  and  even  pres- 
sure by  bandage.    Always  splinting  when  ajqjlicable. 

(B)  AN  ABUNDANT  SUPPLY  OF  CONSTANTLY  CHANGING  BLOOD 
This  implies  the  avoidance  of 

1.  Tension;  as  from  sutures,  too  tight  packing,  or  retained  dis- 
charge. 

2.  Too  tight  bandaging. 

o.  Pressure  on  or  over  the  wound  or  area  of  inflammation,  as 
by  a  splint. 

(C)  REST 

This  implies  the  splinting  of  all  wounds  and  intlammations,  ex- 
cepting the  most  superficial  ones  not  in  the  region  of  joints.  The 
splint  should  fix,  should  be  comfortable,  and  should  not  be  applied 
to  the  wounded  surfaces. 

REDRESSING 
The  surface  dressing,   a   light  one  of  sterile  gauze,   is  changed 
when  soiled  with  wound  discharge. 

30 


Incised  wounds  which  do  well  are  redressed  on  the  fifth  day, 
wlieii  sutures  are  removed  (one  to  two  days  on  the  face).  Should 
infection  develojt,  remove  the  sutures  and  dress  daily  as  for  infected 
wounds. 

Contused  and  Uivcratid  irotinds.  Treat  as  for  incised,  if  pri- 
marily closed ;  if  infected,  <laily  dressing. 

Boils,  ahscesses  and  carbuncles.  Daily  dressing.  Twice  daily 
if  large  sloughs.  Surface  wound  kept  open  by  parattined  lace-mesh 
drainage  till  the  cavity  is  filled  with  healthy  granulations. 


31 


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